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NPI Code Detail

MEDICARE: EMILY ANNE ALBERDA DO

MEDICARE: EMILY ANNE ALBERDA DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
22255A2300XAthletic Trainer

General Provider Information

NPI Number : 1508429499
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY ANNE ALBERDA DO
Provider Business Mailing Address
First Line : 11234 ANDERSON ST
Second Line : GME OFFICE UA-202
City : LOMA LINDA
State : CA
Zip : 92350-1716
Country : US
Telephone Number : 909-558-4085
Fax Number :
Provider Business Practice Location Address
First Line : 11234 ANDERSON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1716
Country : US
Telephone Number : 208-761-1125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2019
Last Update Date : 05/27/2026

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